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Evolving Practice of Nursing and Patient Care Delivery Models

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Nursing is a career that presents those in it with many opportunities. There are a variety of nurses and the field in which they choose to practice is just as varied. There are oncology nurses, school nurses, home health nurses, trauma nurses and nurse practitioners. They work in clinics, hospitals, schools, prisons, mental health hospitals, community health centers and even in law offices. The possibilities available to a nurse are endless. With the advancement of your degree the doors that open are even greater. Nurse practitioners can be found in hospitals, in the operating room, working with a physician or running their own practice or clinic. Healthcare is changing and with nurses being the largest number of healthcare providers that means the nurses role is changing as well. The focus on nursing is evolving and expanding as is the nurse’s primary role in patient’s health and wellbeing. One of the main things that will affect change nationwide is the Patient Protection and Affordable Care Act of 2010 (PPACA).

It is estimated that close to 30 million people who were previously uninsured will be entering into the healthcare system over the next decade. With that increase on an already taxed system, the demand is unmanageable at the current state we are in. One way in which to combat this is with Nurse Managed Healthcare Clinics (NMHC) (Wakefield, 2010). These clinics are ran by a Nurse Practitioner and focus on providing health education, health promotion and disease prevention. These clinics serve not only the population that is most underserved (typically low income, uninsured patients) but also provide a learning environment for nursing students. The push towards public health in the nursing community has always been strong and these nurse driven clinics exploit that strength for the good of the community as well as the healthcare system in general. Many of these clinics have been tied to lower hospitalization rates and better patient outcomes (Thefutureofnursing.org, 2014).

“A survey of 60 NMHCs found that provision of health maintenance services far surpassed that of chronic illness management. While data on NMHCs remains limited in terms of clients served and services provided, existing data indicate that NMHCs provide greater use of preventive services along with care that is high in quality, patient satisfaction, and cost effectiveness. One study noted that DNP nurses at a nurse managed pediatric clinic reported quality of care measures as meeting or exceeding national benchmarks” (LathropMSN, MPH, FNP-BC and Hodnicki, PhD, FNP-BC, FAAN, 2014) . Another major impact on nursing with the Affordable Care Act is the funding that has been granted towards nursing.

The Health Resources and Service Administration is the primary source of funding for nursing education and their cap for funding available to advanced education for nurses has been lifted. The Nurse Faculty Loan Program enables schools to offer loans to masters or doctorate level nursing students interested in becoming teachers and that funding has grown as well. The Nursing Student Loan & Nursing Workforce Diversity programs both help to ease the nursing shortage by enabling students from disadvantaged backgrounds to receive more financial help to aid them in nursing school. “These resources include access to long-term, low-interest loans and partial loan cancellation for nurses who choose to work in parts of the country where there’s a shortage of health care professionals” (Wakefield, 2010).

In discussion with my colleagues about the future of nursing, a common theme noted among all is enthusiasm. One is an Acute Care Nurse Practitioner practicing in the hospital setting, one is an RN that is working in the hospital and currently enrolled in an NP program, and one is a Patient Care Manager that is working towards a Masters in Nursing. Among all of these nurses the one thing they can all agree on is that nursing is evolving. The role of the nurse is no longer to carry out the doctor’s orders and do as they are told. The burdens on nurses to be critical thinkers and have their finger on the pulse of the situation is high. Nurses are at the forefront of how healthcare is delivered and are essentially the “eyes and the ears” of the system. Most of us chose the profession of nursing in the hope that what we do can make a difference.

Having an expansion on our ability to do just that, through the opportunities that the demand on the health system will present, is definitely exciting. Nursing has and will remain the backbone of the healthcare field. Nurses are highly trusted by their patients which presents a unique opportunity for teaching. Nurses who choose to continue their education to the graduate or doctorate level expands on the impact that can be delivered. Healthcare is moving beyond the hospital and is headed towards health promotion and prevention. This is where the NMHC’s will be able to expand on their reach. In Arizona, Nurse Practitioners can currently practice under their own license and are not required to work under a physicians. There are only 14 other states in the US where an NP can practice independently. The view of NP’s from a patient perspective is changing as well which All of my colleagues agree that this will likely expand to other states as the demand on the system is unable to be met by physicians.

In closing, the important thing to remember is how imperative it is for nurses to remain involved and educated so that the field is prepared to meet the challenges that will continue to present themselves with the evolution of healthcare and system by which it is delivered.


Haney, C. (2010, June). New Care Dekivery Modeks in Health System Reform: Opportunities for Nurses & their Patients. ANA Issue Brief, 1-7. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Care-Delivery-Models.pdf

Thefutureofnursing.org, (2014). Nurse Managed Health Centers (NMHCs) | RWJF Initiative on the Future of Nursing. [online] Available at: http://www.thefutureofnursing.org/resource/detail/nurse-managed-health-centers-nmhcs [Accessed 5 Dec. 2014].

Treston, C. (2013). Nurses and the Affordable Care Act. Journal of the Association of Nurses in AIDS Care, 24(5), pp.391-392.

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